Hi all, would appreciate shared experiences. My EP said a while ago on 3mth review after my 2nd ablation he was OK with me stopping the Flecainide and Bisoprolol but I was more cautious. Asked to reduce after my walking holiday in Scotland. Now back n heart on v good behaviour while away I have reduced the Flecainide from 100mg to 50mg am, and Bisoprolol from 2 5 to 1.25. Yest just on this reduction HR according to my garmin is up by 5-10bpm and not settling to relaxe on the HRV measure.
So I took another 1 25mg Bisoprolol so as to do one med at a time ! My last ablation showed no AF but x3 macro-re entry arrythmias.
Appreciate hearing other's experiences?
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Turquoise19
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I’ve never had an ablation and am certainly not qualified, but I do take bisoprolol and I’ve taken flec as a PIP (once last year)- I’ve also reduced my bisoprolol this year from 2.5 to 1.25.
Please can I ask how you reduced the bisop? Did you just half your dose in one day from 2.5mg to 1.25?
Hi Teresa, yes I did reduce from 2.5 to 1.25 in one day as well as the Flecainide. Down from 100 to 50mg am and keeping to the 100mg at night so far. Maybe next week to take down the Flecainide.
However, today I am back on the 2.5mg as I then get mild chest pains when I reduce it n HR goes up by 10bpm. Know of course it will go up a bit but just don't want to strain it. Also as I am wanting to build up some exercise.
I thought that might be the case, that you reduced straight down to 1.25 in a day. This is why your heart rate increased like it did as it was a rebound withdrawal effect. I did that last year, on instruction from cardio and GP when I told them I wanted to try and come off it completely. I went from 2.5, to 1.25 and then stayed on 1.25 mg for a week and then stopped. I’d only been on it for 8 weeks, but it still shocked my system and the HR increased like yours and then higher. I did go straight back into afib within a day. I went straight back into 2.5 mg. It’s good though that you have upped the bisop again since 👍
So when you are ready again - I’d recommend going very, very slowly. I’ve reduced bisop again this year from 2.5 to 1.25 - slowly, by using jewellery scales and a pill cutter (Amazon came in handy lol)…which sounds extreme and a faff and something I never thought I’d ever have to do, but it has worked. I have found that even tiny mg makes a difference in reduction, which is why you need scales. It is just not possible by eye or by using a pill cutter alone. I used 1.25 mg pills rather than cut up 2.5mg. I initially reduced a quarter of 1.25 at a time and stayed on the dose for 2-3 weeks, ( so was taking a 1.25 mg, plus 0.62mg and a .032 mg!) There was a little bit of rebound, but only 3 or 4 bpm more roughly for a day or so, but enough to notice & then it would settle back down quickly. When I got down to 1.25 and an additional quarter, I reduced by 0.2mg every few days 😳 that needs a lot of perseverance and my husband thought I was going mad, but it paid off. I know many will think this sounds to much and a lot wouldn’t be affected by reducing bisop, but I know that fior me, it was the right thing to do,
I’m now on 1.25 and the strange thing is, my heart rate is still a bit on the low side and is roughly the same as it was when I was on 2.5mg . I think if I reduce again, as it is still a bit too low at times, I’d reduce by a few mg every few days and not go down by quarters this time, as the dose is lower overall.
I don’t think you need to be so extreme with the flec with reduction, but I’m sure others will give their advice on that.
I know it sounds extreme what I’ve done….but I really didn’t want to be anywhere like the position I was before as it was horrible. it’s paid off as my heart has hardly noticed me doing it 😊
Wow thanks Teresa for this v detailed reply. I had just thought that because its the next dose down it would be fine. They are already v small tablets.
N like you my BPM are a little low. But 55 bpm is good for me. Also when fit.
I can cope with it being slightly higher just not the mild chest pain I was getting. Ultimately I do not want to get AF or Flutter back ever again
Oops yes… it was quite lengthy too wasn’t it?! Yes, they are small, but they’re certainly powerful. Everyone is different of course and I think we all metabolise pills at different rates which adds to the mix.
On 1.25 - My HR dips occasionally at it’s lowest at the mo, to 55 ( sitting in front of TV) but mainly is sitting around 58 - low 60s through the day. Going upstairs -75 ish. It goes to 115 ish at it’s highest, briefly, walking briskly outside/exercising. I daren’t check what it goes to when asleep as I know it will worry me 😳
I’m glad the chest pains have stopped for you and hope they don’t return 🤞
It's trial and error. I'd be starting with 75mg X 2 not 50. Buy yourself a pill cutter and take it slower. Alternatively take 100 am and 50mg in the evening when you're less active. You could then adjust the Bisoprolol as needed. Bisoprolol lowers the HR so I'd say normal to have the HR rise slightly for a few days while your body adjusts. Just to add, Flecainide doesn't cut easily. Discard the unused half after a few hours - don't keep it to have that evening, or next day.
I've reduced to a half dose in the evenings a while back (Flecainide and Diltiazem) and find it works well.
Give your body time to adjust at each stage - at least a week unless something goes wrong e.g. lots of palpitations or AF - a month or more at each stage is better still.
Thanks Singwell, yes am still dabbling with it. For some reason I feel better taking the 100mg Flecainide at night.
Now back on the 2.5mg bisoprolol as was getting chest pains yesterday when down to 1.25mg.
I have a Garmin watch that measures heart rate variability. And this also goes down to mildly stressed when I reduce the betablocker so I have put it back up to 2.5mg. And seems settled. Am also wanting to work up some exercise slowly so maybe it's OK, to keep it there for now.
Just so don't want to get these arrythmias back again!! My EP said the more burns they do, it does affect the flow of conduction around the heart longer term. So still best to keep to a minimum!!
It is normal HRV to be markedly lower after an ablation, and this can last for 6 - 12 months or even longer. I wouldn't change my medication dosage just based on that.
Not sure if I'm following that exactly, but having a low or high HRV isn't causing the heart to be stressed or not. There's no reason try to "help" your HRV by increasing your beta-blocker.
Yes thx HH, I did read that betablockers improve HRV, they're also protective of the heart when you're building back some exercise.
I think I am obsessing a bit with the idea of improving my HRV to supposedly lessen the stress on my heart .
Not sure if I am right. Just that when my heart kicked out pre ablation my HRV (as measured on the stress reading monitor on my Garmin watch was sky high).
So just made me figure... plus other reading I have been doing on the nervous system and staying relaxed. I still ultimately DO want to come off the blimmin drugs!
Yes, if your HRV goes above about 120mS, thats probably because you are in afib. The variabilty of your heart rate goes sky high during afib. If you have an Apple Watch you can use the HRV history to see when you were in afib, you will probably see it go over 200mS. I got interested in HRV after my Apple watch told me my average HRV had gone from 50mS pre-ablation down to 10mS post-ablation.
Yes thanks Halfheart. Sorry for the late response. I didn't get an alert that you'd replied. My garmin measures HRV through its 'stress response' feature. Mine also went v high when I was in what turned out as a no of arrythmias last Sept. Now still in recovery post ablation 2. And trying to reduce meds. Bisoprolol 2 5mg to 1 25 again today, with resultant raise in the 'stress response' /reducing HRV. Aware also the fitter u are the higher HRV. And not wanting to stress o my heart to prevent more arrythmias. Have u heard about the whoop wrist app that supposedly accurately measures HRV ?
Sorry no experience. My view going cold turkey or reducing slowly, both could work. If I get to reducing my Flecainide (200mgs) I will choose the latter route for sure and take a year to stop completely!
Hi, After my second ablation 5 weeks ago I was told to immediately stop the flecanaide but to continue 2.5 bisoprolol. No issues of AF thus far but I get the odd flutters every day. Review coming up in 2 months and bit nervous about coming off the beta blockers but the ablation was done so I could come off all meds so here’s hoping the AF stays clear.
After ablation I reduced Flec by half and after 6 weeks stopped it. As for Biso I had already stopped it a year previous. And stopped it immediately but my dose was only 1.25 mg. Ask for some advice- everyone is different.
Hi Stony,Actually my last ablation in Feb found no AF but x 3 macro re-entry persistent flutters.
I am finding it OK now reducing the Flecainide so far only by 50mg am, and staying on the 100mg at night.
But when I try reducing the betablocker from 2.5 to 1.25mg it v quickly goes up by 5 -10 bpm. Plus I get mild chest pains. So for now I am sticking to the 2 5mg while I also increase exercise. Not wanting to strain it n risk more arrythmias.
My EP said that the more ablations they do it does affect the flow of electricity in the chambers
I don’t exercise very much in regards anything athletic if you mean that? -I’ve never been a runner or anything. We try to walk everyday briskly for at least half an hour (weather permitting!) I’ve never had high blood pressure or anything, which can be a prob on bisoprolol as it’s lowered it even more. CHADS 0, I’m not on any AOCs yet as I’m 56.My BMI is 23….
You may find, like me that if you do decide to reduce the 2.5 a lot more slowly than you did to 1.25, it will stabilise eventually around the bpm you were on at 2.5. I think the reason it went up that much so quickly, was most likely rebound - as it does happen when reduced so quickly for some people. It might have also contributed to your pains perhaps - but if you get them again you probably should get them checked? Probably best to discuss all this with a medic though, but as I mentioned, they do tend to think reducing is easy. On 2.5mg very occasionally i’d dip to 52 or 53, which I didn’t like, but overall, my HR is roughly the same on 1.25 as it was 2.5, give or take a couple of beats higher here and there throughout the day. I try not to check too much to be honest, as it just induces anxiety a bit for me.
Before bisoprolol my HR was in the early 70s at rest- occasionally dipping to 65 in the evenings, so bisop has overall lowered it 10-15 bpm. When coming off 2.5 mg too quickly last year, it kept shooting up yo the 80s and early 90s at rest just after 24 hrs, I was also highly anxious as well due to the withdrawal which didn’t help, but that’s another story…
Thanks Teresa yes maybe it is the sudden change. Will try the pill cutter on it. So how comes you have AF if all your obs are good. I am also only 57. Bmi a bit higher than yours, tho yes I was more into exercise before this happened!!
Ah, now that’s the multi million dollar question isn’t it? Wish I knew why I had AF. Alcohol and eating late I think was my trigger, so have completely stopped that. Anxiety also a trigger, so am trying to reduce that, which isn’t easy with this condition as you know.I’d had it on and off for about 10 years, but never caught on an ECG and I thought it was ‘palpitations’. I got it caught on an ECG last Autumn at A&E and they diagnosed it. I haven’t had an episode since November though, ( touching loads of wood), just taking the bisop. Just a word of caution if you do use a pill cutter on its own - they don’t always cut it in half exactly which is why I also use scales, I’ve learnt the hard way 😊
Hope you get it sorted & best of luck with it all and hope your ablation this time proves to be successful.
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